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Report of the Department of Health of the Panama Canal for the year ...

Full Text

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enie. its presencee on t
i the past 4 or 5 years, and
l. lt 2 years. If it existed 1
..ch a small extent as to attract
.. growth since it has been under ob
a recent.arrival, perhaps brought ii
body of shallow, clear, still water
grow best in water from 1 to 5 or 6
tom and sending up its long tendril
of the water, where they form a
algae, in which anopheles delight to
It is fully apparent that with th
new population, most of whom, if r
safely will be, it becomes necessal
industrial centers more completely
anopheline mosquitoes. While sm
.. of a mile: or more from a protected

comparative safety
demonstrated fully
and cattle tracked I

:ne istnmus nas Deen recognized
I it has proven troublesome only
lere previous to that time it was
no attention, and such is its rate
)srvation that it is very probably
t by water fowl. Hardly a single
is free from it now. It seems to
feet deep, taking root at the bot-
s until they just reach the surface
close wet mat interspersed with
breed and fish can not penetrate.
e presence on the Zone of a large
not already infected with malaria,
ry to protect our residential and
r than ever from the presence of
lall breeding places at a distance

t center m

, repeated observations
that from large breeding
xogs, we may experience

I

quitoes of all classes, including Anopheles al
tarsimaculata, over a distance of 2 miles or
stretch of open water a mile in width does
barrier. (See Report of Health Department
The presence of the settlers has also aff
among those whose work requires them to
:unsanitated areas, such as the employees of
those on floating equipment, railroad tracl

ay be disregarded with
on the Isthmus have
areas, such as swamps
large invasions of mos-
bimanus and Anopheles
more, and that even a
not oppose an effective
, 1919, with map.)
ected the malaria rate
be exposed at night in
the Dredging Division,
kmen. watchmen. lock

- operators, etc.
... Part of their job
u:i,; toes of the opi
m;:::'amount of malar
Editions, however
! especially along
An increased
families occurred

These men have always had
s, but previously both the
en country were practically
ia resulted from such expos
, the danger has increased
Gaillard Cut where most c

to accept s
workmen a
uninfected
ire. With 1
manifold in
If such wor

uch risk as a
nd the mos-
and no great
the new con-
such areas,
k is done.

incidence of malaria among employees and their
also at Silver City, the new negro suburb of Cristo-

bal on the Atlantic side,
Silver City was built in
screened with 18-mesh

Special
lznt i *n

Panama Canal
~n anU
Wfl7flndelf 0 'tflf

during the I
1917-1919,
copper wire.
Commission
wn si 1. mn In

beginningg of the past
and at that time was
At the time of the
, appointed by the S
m anArl a4-irtna ae i-f i-b e

wet season.
thoroughly
visit of the
secretary of
I nno ra l nnc

-i

1

m l

"airy ana cattle pastures to me soutn. pgi a
high trade winds of the recent dry season, aii .a.. vig.r.
from young West Indians, the screens of Silver City w rp..
to their fate and soon reached a state of disrepair sufficient t
possible a thorough demonstration of the impracticabilityf ..
Commission's recommendation. Shortly after the advent ,i thF
rainy season, the influx of mosquitoes into Cristobal and Colonfri
distant areas began. As in previous years at this season, na
screens of Colon Hospital each morning were mosquitoes of :wqp
kinds, though not nearly in such numbers as in former years 1eo
any ditching was done in the distant Margarita Road swamp ap
Malaria shortly appeared in Silver City, until the number of caws
were more than five and one-half times its usual incidence thiw
After this brief but illuminating experience the Health. Departmrt-t
made urgent representation to the Constructing Quarterma trM:
Division and Silver City was rescreened, with an immediate respome
in the malaria rate. Screening; though expensive, is still a vital
element of defense against malaria in the Canal Zone. Even za
Ancon and Balboa, which are least exposed to anopheles fights, A
dangerous condition would probably result if without screens during
certain seasons of rainfall, from anopheles bred more than a mile
away.
Another factor believed to help increase the malaria incidence

among colored
the increase occ
unsettled parts
employees have
in sanitated are
early evening I
present, are moo
The Republic
into the interim
automobiles no\

malaria

havin

employees (in w
urred) is that in
of the Zone to r
been allowed to

;as.
hours,
st act.
of P

II

g

it is easy to believe
Every case of r
reported to the C
effort to trace the
and recreation of t
in any of them is
clearly traceable e

greater part of
tion to opening
ulturists, many
on vacant lan ;
til far into the
mosquitoes, i

.

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continuing the building of good roads
afford delightful drives for thea mr"'"an .
It is difficult to trace with certainty
oese drives into unsanitated areasi4" f.:.- ..
-- "- .. .. ..'' l:::e. "^... ..
cases do so originate. .. .: ...
ed by a Panama Canal physidcht fi..-s
officer and is carefully analysed iii ..a -
ection. The place of work, residfate, 'i
noted and the presence of mosquitoes e.
if possible. Unless the infection .
case is charged to the district in which -"
S. m:::3" ." ...::

i :... ; i*ve as definitely as possible at a knowledge of the necessity for and
Srespite of our efforts at sanitation, and the-foregoing explanations
S.... various increases in malaria rates are offered only as a result of
S*re:,; :fu study and with an accurate knowledge of underlying conditions
ni;, \ ^ the field. The sanitary inspectors are all capable men of long
Sexperience, and their work is under systematic, routine observation
by supervising officials, making any sort of gross negligence or un-
Sapproved practice impossible.
The preliminary heating of oil to facilitate its passage through
the piping and nozzles of spray pumps, without the use of "larvacide"
or other diluting substance, has thoroughly demonstrated its prac-
ticability and economy. A particularly efficient type of pump has
contributed much to its success. The one used is strongly constructed
of cast iron, with brass plunger and valves. A geared handle and
an ample air chamber in the stand permit of easy operation and a
continuous fine spray of oil. (See cuts No. 1 and 2). The drag or
mop, made of strands of rope, used in cleaning and oiling open earth
and concrete ditches has also, after extended use, proven efficacious
and saves greatly in time, labor, oil, and cost. Earthen ditches so
oiled require less frequent cleaning of vegetation from the sides and
bottom. In fact, a certain amount of growth seems to add to its
effectiveness as the oil is retained on the stalks and leaves, to be
given off as an effective film for some days following its application.
(See Cuts No. 3 and 4). These methods were more fully described in
last year's report. A further economy in the Pedro Miguel Lake region
will result from having placed the sanitary division oil tanks at points
convenient to the lake's margins and connecting them to the oil
supply line, so as to obviate the necessity for distributing oil by
means of barrels and tank wagons. (See cut No. 5).
H.o

Antiplague work.-The work of making the Canal Zone prc
the introduction and spread of plague was energetically
during the past year. Fumigation and other quarantine p:
are described elsewhere in this and previous reports.
efficient rat-guarding of lines from ships is specifically a f
the quarantine division, the sanitary inspectors, the police
docks, and other employees take an active interest in this
preventing the invasion of rats from ships and it is believe(
being do efficiently and practically. A systematic ins,
reside ad industrial plants of the terminal cities is n
to Pgy^B^.. rat harbors and nesting places. Forl
circ g Governor, pointing out the cause anm
_a _-- -

)of against
continued
recautions
While the
unction of
guards at
feature of
d that it is
pection of
maintained
tified by a
d means of
I .1 1_

r

interstices of these stones. The spaces under the docks themselves
have been protected recently by means of concrete wing walls cutting
off any rats living under them from having access to the shore
without swimming considerable distance; but the mole and the water
front elsewhere can not be made rat proof in any such manner at a
reasonable expense. The entomologist of the Board of Health

Laboratory
and sent t(
At the s
comparati
carried 54
fleas were
While rat-
Panama, 1
chants of
materials.
Indians, e
hend as w
is being
vention as
In the
cooperation
approach
reduction
the Isthm
freed from
jungle of
frequently
trapping o
in the terry

und no fleas on 42 rats caught on the Cristobal docks
n for examination some years ago.
time the rats of Panama City were found to have a'
high rate of flea infestation. One small brown rat
;, a roof rat 41, and on three half-grown black rats 103
nd. All these were Xenopsylla cheopis Rothschild.
if construction has been insisted on for many years in
e still exists the large problem of teaching the tier-
city the proper method of storing merchandise :and
nama 'has a large number of foreigners, Chinese, iwt
engaged in business, and these are slow to cofipre-
s to carry out orders of the health officer. An effort
e to teach them the economic importance of rat pre-
.1 as its sanitary significance.
e shop and storehouse areas of Balboa the hearty
f responsible officials has produced a condition that
e ideal as regards rat-harboring places, a marked

in the rat population being apparent therein. Of course
us--or even the terminal cities-will never be entirely
rodents by our efforts, for the fields and partly cleared
Panama abound with rats of sylvan species and these
are caught in the environs of the buildings. Systematic
If rats for the purpose of post mortem examination is done
linal ports. Rat poison (barium carbonate) is used at inter-

vals of not more
Fly prevention.
cities have at all
tropical commun
do have seasonal
to attract attenti

than one month.
,-While the Zone and t
times remarkably few flie
cities and with the States
or incidental invasions of
on of the sanitary forces a

to eliminate them. During the
basins and also house drains som
they are carefully cleaned or

conceal a reserve stock of mania
cover. In the effort to encourage
. ... __ .... I L.-A

dry season

. i.
b H : .
.

... .!
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-
i*

he terminal Panamanian
s as compared with other
in the summer season, we
numbers of them sufiiit.
nd cause redoubled iffts
storm water,.' .ait et itc

ir :n# until the case is hopeless.
b 90'or6lity.-The infant mortality rate
iceties of Colon and Panama, and of the
I-. sla has been as follows:

A *
4~5>.

~~H.
Ebjr:p

1919.

155.29
154.47
1 702

per 1,000 live
Canal Zon fC
r. .
1 I

1920.

142.21
155.30
3A 36

1921.

139.28
173.95
81 62

: loedd................................ 154.00 130.00 134.73 "
total population... ................. 113.67 95.09 96.65 tj
. .*i. : .. **..... : .I
:e.he rates do not show the progressive rate of diminution that
.ldesired.. Economic conditions, with mounting cost of living an
reduction in Panama Canal forces, have been very bad among t

Si .poorer classes for the past several years, and we may perhaps-"
S thankful that the rates do not greatly increase. Poverty and 'tgnt
rance, the latter even among those who have not felt the pinch of noi
employment, are blamed for the rates. Milk is scarce and expensive<
: ice is high and many have no facilities for keeping it; quarters i
the Panamanian cities are costly, cramped, and ill lighted. Depend
ing upon midwives and other ignorant persons for medical treatmed
.. and dreading the cost and separation incident to hospital treatment
the lower classes frequently do not call upon a competent physician
i.. _" until it is too late-and often not at all until death has occurred and

burial permit must be secured after filing a physician's certificate of
death. The Health Officers of the two Panamanian cities are constantly:

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Er H H. V* t ;..M .H..
Yewoart Total tous otalton- "-':!" .1
received.- detedo T.isbtl
.. ." .. : ".
1918.......... ........... 9,717,452. 154,176 :.: $8 .. ..8 O3a.@,
1919............. ...... 10,779,529. 161,37
1920......... .. .... ....... 17,793,683 48,172 i2:486 19, a266BO
21. ............... ...... 20,232,45.6. 80,788 .. 4,. 1 4.1.
H* r .
Non----n previous reports the total tons received intlude. tuuanage U
Cristobl and Balboa either from the sea or from the Canal. In the si d
total tons received represented the gross tonnage of all ships actually. pauiag
of the Quarantine Division, with the exception of small erit entuigi thei a.. ...
The number of vessels handled in 1922 was 3,97l,!ijS
average oss per s ap 1 cents- .. .
An endeavor has been consistently made. :to "move~
that is, to afford to patrons of The Panama Canal qa
tion with the smallest possible loss of time. As ao
policy "a sweet reasonableness" has been .followed in th:i
of quarantine measures; old precedents. and procedurem.H
been slavishly followed and a certain elasticity has be
which has operated to the great benefit of shipp...ng A,
time, there has been an adequate health. protection
Zone and the Republic of Panama, quarantinable .'
successfully excluded with the minimum minterfrenc it
Sa .. *. E, ...."...'S
Yet there has been no evasion of the moral obli atioil to pir:..
far as possible the passage of disease .to the other ts. oftsi.
This policy has.been made more ea sy'by the als o
eradication of yellow fever and the fact hat tyrph Ee# *!ip i
thrive ini warm, humid, sealevel climates. Thifi
of ships using plague ports, for the destruction, of gpi4up
S H^ V ^ :r -,, ,- _-_ ,x: a _, 1, ..n: .:

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aj

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Is:
'II

illki

e;I

m

oy

bis, acousmed in the past in
isr ptienta to the Weat Indie
amS l ever-isncrasing number of
Armraglments were tlheref oe
house .tender Favrie to take 41
ees and their, families to Barb
:his relieved some of the cong est

:, tl re while t
S. ,room and the
,9, wh the exception of
he patients. As a result
er cent and 70 per cent
Mti]" It I

jit:

continued high: All of the milk is pasteurized, and exaini
made of specimens at'the Board of Health Laboratory .
intervals. These e minations have shown uniformly loa
cunts.
Piggery.-Ther .Ire 351 pigs and 58 hogs remaining
of the year.. The ,pggery has proven one of the .m
divisions of our farmingg activities, the total inco
Pastp .. .514.07.
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HOSPITAL.

4. :n.j.A

' s. AArn, Su
, .

The work
manner throt
is frequently
part of thej.

Lthe

t '**
gpgnQ

t&. i

ii

V~

busy di .r
The dispensary tic ihct
children, and manpr eofes..
During the year, with our
utility men and the .erVi. ..

nd secondary lesion).-
d in these tissues, both
the pathologist at the
ie incidence of tonsillar *

ed

was 2.21

per cent.

chemist began a series
brief report was made
ie Tropics," which has
considerable evidence

he blood is

materially

CT
; :'FRM
p -~i;5 -:~
.INI H -"i

pics than in the temperate zones.

i~elar~il

:setuicus

(Bacillus

bovisettiius). (Pasteurella

at autopsy from heart's blood and from hip-
Epoqfol|ste n bull calf from Corozal Dairy, August 1, 1922.
% tqtksp foundat autopsy was Omphalophlebitis Septica
... : ** *..eaorum). This 'is the first time that this